LMI-18MULTIDISCIPLINARY APPROACH TO PERFORMING AWAKE CRANIOTOMY FOR TUMOR RESECTION IN PEDIATRIC PATIENTS. A CASE-REPORT FROM A PEDIATRIC-ONCOLOGIC HOSPITAL IN MEXICO

Abstract

Background:Craniotomy for resection in awake patient is required for tumors involving eloquent areas in cerebral cortex: sensory-motor, memory and/or language cortex. The goal is to perform real-time evaluation, to avoid damaging these areas. This is seldom performed in children, because there is little experience and is difficult to do; complications, such as airway obstruction, hypoxemia or seizures can occur. Therefore, a multidisciplinary and well-trained team involving anesthetists and psychologists, is required for pre-surgical conditioning of the child and management for anxiety and/or fear at surgery.OBJECTIVE:Todemonstrate the feasibilityand importance for accounting with multidisciplinary, well-trained team to perform complex procedures such as craniotomy/resection in awake child with brain tumor. PATIENT AND Methods: We report a male 11 year-old, with a 14-months clinical course, starting with behavioral abnormalities and a complex-partial seizure. 2 months afterwards, intermittent headache, nausea and vomiting appeared. 10 months later, he was taken for medical evaluation. MRI revealed an intrinsic right-parietal tumor behind primary sensory-motor cortex. At surgery, he was awake for resection, and clinical evaluation for sensory-motor and language functioning was performed. Results: Gross-total resectionwas achieved. Histologic diagnosiswas pleomorphic xanthoastrocytoma(WHOgradeII).6weeks after resection, the childwas intact for neuro-psychological performance. Conclusion: A multidisciplinary, welltrained team that works in a coordinated fashion, is necessary to achieve optimal Results in performance of complex procedures required for treatment of children with brain tumors. These teams must have experience in management of potentially harmful situations occurring in these procedures.